Care for Alzheimer's patients improves by treatment stagnant

When Patrick Conaboy, M.D., was a teen, he was among the family members who helped take care of his grandmother.

"She lived to exactly her 100th birthday, as she always told us she would," Dr. Conaboy said with a chuckle.

Grandma Conaboy had her wits about her up until the very end. The same cannot be said for the many Alzheimer's patients Dr. Conaboy treats on a daily basis. And, unfortunately, there's only so much he can do for them.

Geriatric care is among the primary focuses for Dr. Conaboy, a longtime family practitioner who shares a practice with Dr. Peter Cognetti in the McAuley Building, 802 Jefferson Ave. He's also the medical director at Lackawanna County Health Care Center and Holy Family Residence, as well as the outpatient medical director for Mercy Hospice.

As he looks back on the more than two decades he's been practicing, Dr. Conaboy doesn't see much to get excited about when it comes to the treatment of Alzheimer's disease.

"I'd like to say there have been great strides, but there have not been great strides. ... They've made a lot of great commercials," said Dr. Conaboy, referencing the TV ads for Alzheimer's drugs that purport to do all manner of wonderful things they don't actually do.

"It is tough, because what we have to offer is so minimal," he said. "What I would like to see is something that actually changes the course of the disease, rather than just slows it down. That's the holy grail."

When Dr. Conaboy was starting out, there was very little in the way of pharmacological treatment of the disease. Among the first drugs he remembers coming on the market was Cognex, which proved unpopular due to its four-times-daily dosage requirements. After that came other Alzheimer's medications like Aricept, Exelon, Razadyne and Namenda, all of which only manage to slow down the disease, not stop it outright, he said.

"It's still a train chugging down a track," Dr. Conaboy said.

Where there has been a marked improvement is in the realm of social services, he said, citing the numerous Alzheimer's support groups, first-rate assisted-living, skilled-nursing and hospice care - "how stable and positive an environment the Alzheimer's units are," he said - to adult day centers like Geisinger LIFE at Marywood University, which give caregivers the chance to keep loved ones at home when they would otherwise have to go into a nursing home.

"That way, (the caregiver) can participate in their loved one's care and feel a little less pain and guilt," said Dr. Conaboy, a University of Scranton and Georgetown Medical School graduate who spent 10 years as an Army physician before returning to the Scranton area in the early 1990s.

While there's still no definitive test to diagnose Alzheimer's - there have been advancements in PET scan technology, and a recent study published in the Archives of Neurology detailed a remarkably accurate spinal fluid test for patients with significant memory loss - physicians now have a better handle on separating the disease from other forms of dementia, as well as conditions that aren't dementia but mimic its symptoms, like depression, circulatory strokes, vitamin deficiencies and substance abuse, Dr. Conaboy said.

And there's been a greater push to make early diagnoses, but given the dire outlook, "nobody wants to be diagnosed," he said.

Because of these earlier diagnoses, patients have time to make end-of-life plans "before losing that competency," Dr. Conaboy said. Those decisions include everything from straightening out finances to determining whether to be kept on a feeding tube during the final stages of the disease.

The consequences of not making these wishes clear can be "brutally hard" on the loved ones who end up having to make those decisions, Dr. Conaboy said.

"Not only is the right thing done by your wishes, but you save your family so much pain," said Dr. Conaboy, acknowledging that "to contemplate losing everything you are is very distressing."

"What's good for me is I get to bring to my patients the experiences I've had with 2,000 other patients over the years," he said. "I can help them get rid of some of their fears. And help them do what's right for them. So it's not as scary."

Contact the writer: jmcauliffe@timesshamrock.com

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